Ideally, candidates will be in their late 20s or older. Why? When you’re in your early 20s, it’s hard to know how much more hair you’ll lose in the future. Plus “younger patients tend to have unrealistic expectations,” says Dr. Epstein. Most older patients already show signs of male- or female-pattern balding, making it easier for surgeons to predict future hair loss and create a hairline that looks natural over time.

You’ll also need enough healthy donor hair for the surgeon to harvest. If you’re thinning all over or already have significant hair loss, a hair transplant probably isn’t right for you.

There are two different techniques: follicular unit transplantation (FUT) and follicular unit extraction(FUE), also called follicular unit excision.

With FUT, the surgeon makes an incision to remove a strip of hair from the back of your scalp. That incision gets stitched up, and you’re left with a fine-line scar that’s usually concealed by hair. This technique should produce a lot of viable grafts.

“With FUE, we move hairs one at a time, so there’s no linear scar,” says Dr. Epstein. A FUE procedure allows the surgeon to remove hair follicles not only from the scalp, but also from the beard, back, and chest, for transplantation into the scalp. “It’s not the main source of donor hairs in FUE, but it’s an excellent option for patients who have the need for a large number of grafts, or who’ve had a prior transplant with scarring of the scalp donor area,” he says. Keep in mind that if you’re getting FUE, the surgeon usually will shave the donor area before extracting hairs, so you’ll need to plan around the procedure. There is, however, the option of undergoing what is called a “no-shave” FUE, a more time-consuming and demanding technique that allows the surgeon to harvest all of the grafts without needing to do any trimming of the donor area. Be aware, the procedure isn’t exactly scar-free: You’re left with tiny dots where the hairs were extracted. But once your shaved hair grows back, those spots should be undetectable, even if you keep your hair short.

Before the procedure is performed, people are typically sedated (awake but relaxed), and the scalp is numbed with a local anesthetic. “It was a little painful but bearable,” says RealSelf member R. Ahmed. After the donor grafts are obtained, the surgeon creates tiny holes with tiny blades or needles, then places the grafts (containing one to three hairs) in each one. “The aesthetics are absolutely determined by how the surgeon makes the recipient sites—the angulation, the pattern—and the distribution and placement of the grafts,” says Dr. Epstein. As many as 2,000 or more grafts can be transplanted using this meticulous, one-by-one process, so a hair transplant can take up to eight hours. “It’s not a speedy process,” says Dr. Epstein. “The goal is to get the best regrowth of hair by properly handling each graft.”

Some physicians use the robotic hair transplant device Artas to extract the grafts, and even to make the recipient sites prior to implantation. Other physicians use NeoGraft, a device that can harvest the FUE grafts. NeoGraft is often marketed to doctors as a way to delegate the transplant procedure to technicians that are hired for the day, as the company provides for-hire technicians. These two machines, despite how they are marketed, do not automatically deliver good results. Excellent results are achieved with a variety of FUE-harvesting devices when they’re in the hands of a dedicated hair-restoration expert.

According to the International Society of Hair Restoration Surgery, the world’s largest organization of physicians devoted to performing hair transplants, more than half of all hair-restoration treatments done in 2016 were FUE. This increase has led to a shift in who’s doing many of these procedures: Increasingly, you’ll find treatments being performed by technicians rather than physicians, especially when proprietary devices are used. Industry experts say you’ll get the best results with a licensed physician who has extensive training in hair-restoration surgery. “You want to make sure your doctor is doing the work,” says Dr. Epstein. A hair transplant is a surgical procedure, so not doing it properly can put the patient at risk. A technician also lacks aesthetic training, and may even misdiagnose a hair disorder that’s caused by an underlying disease.

RealSelf Tip: At your consultations with hair- transplant surgeons, ask to see a lot of pictures. “Make sure they’re photos of the doctor’s patients and not from the manufacturer of the device,” says Dr. Epstein. You’re looking for results that appear natural and believable.

“Recovery is usually a piece of cake, especially in the donor area where the grafts were taken out, which should be fully healed in three days,” says Dr. Epstein. You may experience mild scalp tenderness and swelling, along with some scabbing and crusting for six to seven days where the hairs were implanted. “If follicular unit extraction is performed, the donor area on the back of the head will be essentially healed and not noticeable within 7–10 days,” says Dr. Matthew Richardson, a Frisco, Texas, facial plastic surgeon, in a RealSelf Q&A.

For the first five days, you’ll want to take a gentle approach when washing your hair. Use a mild shampoo, without harsh detergents, and don’t scrub aggressively (you don’t want to dislodge a graft). After that, it’s safe to resume your usual hair washing habits. You can also start exercising again five to seven days after the transplant.

Two to three weeks post-transplant, the implanted hairs will fall out. But don’t worry: They’ll grow back. “The new hair starts to grow three to four months later and continues to grow for a lifetime,” says Dr. Epstein. At about 6–10 months post-op, you’ll start to see real results as the new hair grows in. By 10–12 months, you’ll see 90% of the results of the regrowth.

RealSelf members say they paid, on average, $7,000 for hair transplant surgery. That price can go as high as $18,000, according to Dr. Epstein. It all depends on who’s performing the procedure, the number of hair grafts needed, the device used, and how much work is needed. “Charging by the graft can be confusing because the number of grafts doesn’t correlate to the number of hairs. One graft at the crown can have four hairs in it, whereas one graft from the frontal hairline has a single hair,” says Dr. Ramtin Kassir, a facial plastic surgeon in New York City, in a RealSelf Q&A. “Also, more grafts placed doesn't necessarily mean they'll all survive.”

There are several nonsurgical options for hair loss, though none offers the no-maintenance permanency of a hair transplant. Still, if you want to avoid surgery (or the hefty cost), here are a few other ways to help regrow thinning hair.

• Platelet rich plasma (PRP): This treatment uses injections of your blood’s own platelets, full of growth factors and proteins, to stimulate hair growth. Dr. Epstein says that it works in about 60% of patients and needs to be repeated every four to six months (or more frequently with certain PRP systems) to maintain results.


• Low-level laser therapy (LLLT): Some LLLT devices, like HairMax and CapillusPro, are approved by the U.S. Food and Drug Administration for at-home use on thinning areas. You’ll need to use them a few times a week to stimulate hair growth, and they take six months to work—plus you’ll have to keep using them to maintain your results. A study by the University of Miami Miller School of Medicine shows these devices to be safe and effective.


• Scalp micropigmentation (SMP): In this procedure, tiny dots are tattooed in between hairs on your scalp, so hair looks denser and you’ll see less visible scalp.


• Propecia: This daily prescription pill treats male-pattern baldness by decreasing DHT, a male hormone that plays a role in hair loss. The drug can also be prescribed to menopausal women. It takes up to three months to make a difference, and you’ll need to continue taking it to keep the new hair you’ve grown.


• Rogaine: This over-the-counter topical treatment contains minoxidil, which revs up follicles and lengthens hair’s growing phase. You should see a 25% improvement in three months and more with continued use. Like the other treatments we’ve mentioned, once you stop using them, you’ll lose any gains.